National Provider Identifier [NPI]: |
1134112501 |
Last Name Of The Provider |
WRENN |
First Name Of The Provider |
CHRISTOPHER |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1128 MEDICAL DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
TYLER |
Zip Code Of The Provider |
757012109 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Allergy/Immunology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
18 |
Number Of Services |
11132 |
Number Of Medicare Beneficiaries |
439 |
Total Submitted Charge Amount |
243629.5 |
Total Medicare Allowed Amount |
112664.42 |
Total Medicare Payment Amount |
80912.94 |
Total Medicare Standardized Payment Amount |
82858.02 |
Drug Suppress Indicator |
* |
Number Of HCPCS Associated With Drug Services |
|
Number Of Drug Services |
|
Number Of Medicare Beneficiaries With Drug Services |
|
Total Drug Submitted ChargeAmount |
|
Total Drug Medicare AllowedAmount |
|
Total Drug Medicare PaymentAmount |
|
Total Drug Medicare Standardized Payment Amount |
|
Medical SuppressIndicator |
# |
Number Of HCPCS Associated With MedicalServices |
|
Number Of Medical Services |
|
Number Of Medicare Beneficiaries With Medical Services |
|
Total Medical Submitted Charge Amount |
|
Total Medical Medicare Allowed Amount |
|
Total Medical Medicare Payment Amount |
|
Total Medical Medicare Standardized Payment Amount |
|
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
31 |
Number Of Beneficiaries Age 65 to 74 |
241 |
Number Of Beneficiaries Age 75 to 84 |
142 |
Number Of Beneficiaries Age Greater 84 |
25 |
Number Of Female Beneficiaries |
287 |
Number Of Male Beneficiaries |
152 |
Number Of Non Hispanic White Beneficiaries |
409 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
425 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
14 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
5 |
Percent Of With Asthma |
20 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
7 |
Percent Of With Chronic Kidney Disease |
9 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
19 |
Percent Of With Diabetes |
22 |
Percent Of With Hyperlipidemia |
61 |
Percent Of With Hypertension |
60 |
Percent Of With Ischemic Heart Disease |
27 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
46 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
0.7953 |